Arteriovenous Fistula after Percutaneous Vertebral Angiography

Abstract

More than a hundred arteriovenous fistulas on the vertebral arteries, most of them after penetrating injuries, have previously been described (ELKIN & HARRIS 1946), but ARONSON (1961) was the first to demonstrate these fistulas arteriographically.Although SUGAR et colI. as early as 1949 mentioned the possibility of an arteriovenous fistula as a complication of percutaneous vertebral angiography, these fistulas are apparently uncommon, as only a few cases have been described in the literature since OLSON et colI. in 1963 published the first.The three additional cases of this complication reported here suggest that it is perhaps not as rare as has been presumed. As they are to be included in a future paper (JACOBSEN et coll.), which also describes two fistulas after closed injuries, they will only be summarized here. Case reportsCase 1. Male, aged 2 I, with a subarachnoid haemorrhage without focal neurologic symptoms or signs. Bilateral carotid angiography and percutaneous left vertebral angiography, undertaken by a less experienced operator, revealed nothing abnormal. After this last examination the patient was troubled by tinnitus and he was re-admitted 7 months later for further investigation. This revealed a machinery murmur over the middle of the left side cf the neck, and 22 --653272. Acta Radiologica Diagnosis 5 (1966) 337 at MCMASTER UNIV LIBRARY on July 25, 2015 acr.sagepub.com Downloaded from 338 JACK LESTER Transremoral catheterization demonstrates arteriovenous fistula on the left vertebral artery 6 months after percutaneous vertebral angiography. an arteriovenous fistula of the left vertebral artery was demonstrated by transfemoral catheterization (see accompanying illustration).Case 2. Boy, aged 14, with attacks of rotatory vertigo, tinnitus and headache. The left plantar response was extensor, but no other abnormal neurologic signs were found. On suspicion of a vascular malformation, left vertebral angiography was done by a less experienced operator. The angiography revealed nothing abnormal. After this the tinnitus changed; from a humming noise it turned into a rhythmic, blowing sound. The remaining symptoms were unchanged. The patient was re-admitted six months later and a machinery murmur was auscultated over the left side of the neck. Transfcmoral angiography revealed an arteriovenous fistula on the left vertebral artery similar to the one found in case I.Case 3. Woman, aged 26, with a six months history of rotatory vertigo and headache. For two weeks she had had buzzing in both ears. She was admitted to another hospital and on suspicion of a space-occupying infratentorial lesion left-sided percutaneous vertebral angiography was attempted. The examination was unsuccessful, as the needle could not be held in position in the artery. Sixteen ml Urografin 60 % was injected, but no intracranial filling was obtained. After this, the tinnitus increased and a rhythmic, blowing sound, which had not been present before the examination, could be heard on the left side of the neck. The patient was transferre...

Surgical Neuroangiography

“…Due to the close proximity between the vertebral artery and the paravertebral venous plexus, arteriovenous fistulas following trauma and direct puncture vertebral angiography are relatively more frequent than pseudo aneurysms (see Chapter 6, VAFs) (Davis 1983, Dutton 1970, Jamieson 1965, Lester 1966, McDowell 1971. Due to the close proximity between the vertebral artery and the paravertebral venous plexus, arteriovenous fistulas following trauma and direct puncture vertebral angiography are relatively more frequent than pseudo aneurysms (see Chapter 6, VAFs) (Davis 1983, Dutton 1970, Jamieson 1965, Lester 1966, McDowell 1971.…”